After the CalMatters report, Newsom signs legislation to help birth centers

from Kristen HuangCalMatters

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Women in California today have fewer places to give birth than they did a decade ago. Legislation signed this week by Gov. Gavin Newsom aims to create more opportunities for them by making it easier for birth centers to operate out of hospitals.

The “Freedom to Childbirth Act” by Assemblywoman Mia Bonta, D-Oakland, streamlined the onerous licensing requirements that have prevented birth centers from gaining state approval. Without a license, birth centers often cannot contract with health insurers or Medi-Cal. This leaves patients who cannot pay in cash unable to use midwives or birthing centres.

The legislation was introduced and signed into law after Cal Matters reported over the past two years revealing that large areas of California they have no hospitals or birthing centers after dozens of closures. In some areas, pregnant women may have to drive two hours to give birth in a hospital.

“The fact that (CalMatters is) cited in every letter of support sent to the Legislature and to the governor’s office asking for his signature speaks volumes,” said Sandra Poole, a lobbyist at the Western Center for Law and Poverty, which co-sponsored the legislation. “The information you provided was fundamental to the work we did in this area.”

Birth centers, most often owned and operated by midwives, specialize in low-risk out-of-hospital births. Research shows that midwife-led births in birth centers are safe and lead to fewer interventions such as caesarean section.

In the last three years, at least 20 birth centers have closed in Californiaaccording to reports from CalMatters and the California branch of the American Association of Birth Centers. Of the approximately 30 remaining establishments, only four are licensed by the state public health office.

The closure of the birthing center comes at the same time that hospitals have closed dozens of labor and delivery units. Nearly 60 maternity wards have been closed since 2012according to a CalMatters database.

The new law removes the mandate that birth centers operate within 30 minutes of a hospital with labor and delivery services and eliminates duplicative Medi-Cal requirements. The measure passed unanimously in the Assembly and Senate.

“Bureaucratic burdens should never get in the way of proven solutions to provide accessible and affordable health care for Californians. By signing (the bill), our state has taken a much-needed step to address the maternal health crisis,” Bonta said in a statement.

Survey: More than half of women consider midwives for childbirth

The new law is a crucial step toward more accessible birth centers and out-of-hospital births, advocates say.

“When we first started looking at this problem, there were 10 licensed birth centers on the state’s website. Then you start calling people and it got to six, and now we’re down to four,” Poole said. “It’s certainly going in the wrong direction.”

Poole said she hopes the relaxed regulations will encourage more birthing centers to open and allow those who have given up their licenses to try again. It would also make services more accessible to low-income families. Medi-Cal, the state’s disability and low-income insurance program, pays for half of all births in the state.

Most births happen in hospitals, but midwives are delivering an increasing number of babies in the state. Planned out-of-hospital births have increased by 30% over the past decade, even as birth rates overall have declined, according to data from the Medical Board of California.

A A 2018 California Health Foundation study found that more than a third of pregnant patients would be interested in having a midwife for a future birth. This interest was highest among black women. More than 50 percent of women who wanted a midwife at birth said they didn’t use one because insurance wouldn’t pay for it.

Cindy Haag, a licensed midwife, has directed Pacifica Family Maternity Center in Berkeley for 13 years. At first, she tried to get a license, thinking it would be easy. Instead, Haag said the process is difficult and confusing. The health department didn’t even know what a birth center license was when she applied, Haag said, a story many midwives who have tried to get licensed have told CalMatters. The request was denied.

Without a license, she could not see Medi-Cal patients.

“It’s really sad because it changes diversity and accessibility,” Haag said.

In recent years, Haag has reached an agreement with the local Medi-Cal plan to move some of their patients who want to give birth with a midwife out of the hospital. Still, without full licensing, a birth center is limited in the amount it receives for Medi-Cal patients.

“We’re doing the right thing because we care about affordability, but it’s not about our financial gain,” Haag said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.